Kutner Nancy G, Zhang Rebecca, Huang Yijian, Wasse Haimanot
United States Renal Data System Rehabilitation/Quality of Life Special Studies Center, Department of Rehabilitation Medicine, Emory University, Atlanta, GA 30322, USA.
Arch Intern Med. 2011 Jan 24;171(2):119-24. doi: 10.1001/archinternmed.2010.361. Epub 2010 Sep 27.
Few US patients with kidney failure start treatment on peritoneal dialysis (PD) despite its potential survival, quality of life, and cost-saving benefits. We investigated patient awareness of PD and variables associated with PD selection, including dialysis unit ownership and geographic area.
In a cohort study, incident dialysis patients identified by the Centers for Medicare and Medicaid Services (CMS) and included in the United States Renal Data System (USRDS) were surveyed from 2005 to 2007 for the USRDS Comprehensive Dialysis Study. Participants reported whether PD had been discussed with them before they started regular treatment for kidney failure, and initial dialysis modality was verified in the USRDS patient registry.
The proportion of patients in our study cohort who reported that PD had been discussed with them (61%) was higher than in previous surveys, but only 10.9% of informed patients initiated PD. With patient demographic and clinical characteristics controlled for, the proportion of informed patients who started PD differed substantially across large dialysis organizations. Substantial variation in selection of PD was also evident among patients starting dialysis in the 18 end-stage renal disease Network areas.
Despite patients' early awareness of PD as a treatment option, PD selection was low in this national cohort. Factors associated with PD selection merit continued study as CMS seeks to improve quality and cost-effectiveness of kidney patient care.
尽管腹膜透析（PD）在潜在生存率、生活质量和成本节约方面具有优势，但很少有美国肾衰竭患者开始接受腹膜透析治疗。我们调查了患者对腹膜透析的认知以及与腹膜透析选择相关的变量，包括透析单位所有权和地理区域。
在一项队列研究中，2005年至2007年对医疗保险和医疗补助服务中心（CMS）确定并纳入美国肾脏数据系统（USRDS）的新发透析患者进行了USRDS综合透析研究调查。参与者报告在开始定期治疗肾衰竭之前是否有人与他们讨论过腹膜透析，并且在美国肾脏数据系统患者登记处核实了初始透析方式。
我们研究队列中报告有人与他们讨论过腹膜透析的患者比例（61%）高于以往调查，但只有10.9%的知晓患者开始接受腹膜透析。在控制了患者人口统计学和临床特征后，开始接受腹膜透析的知晓患者比例在大型透析组织之间存在很大差异。在18个终末期肾病网络地区开始透析的患者中，腹膜透析选择的显著差异也很明显。
尽管患者早期知晓腹膜透析是一种治疗选择，但在这个全国性队列中腹膜透析的选择率较低。随着医疗保险和医疗补助服务中心寻求提高肾病患者护理的质量和成本效益，与腹膜透析选择相关的因素值得继续研究。
